ALS, MS or Anxiety?

[Eva_C]

Hi, I have some troublesome neurological symptoms, and I don´t know if they are related. For about a year a have periods of dizzy spells/vertigo and balansce problems on and off. Aboult six months ago I began to experience a strange feeling in my left arm. This autumn it all got worse. From a month ago my legs are now trembeling when I go shopping, I tend to drop things in the supermarket and it feels like my legs are going to collapse. The last month I have noticed decreced motor skills in my left hand, arm and shoulder, my right foot (opposite side) is also troubleing me, I think I see athrophy in inside of the foot and the foot does defenitly not look like the left foot, I feel like something is "missing" under the foot when I walk and have some troubble balancing on that leg.. I also have fasciculations almost 24/7 at that site. Facsciculations occcur also wery often every day in other random muscles. My left hand has some athrophy, confirmed by a GP, in the tendon muscle. I get easily tired in my left arm and feel stiffnes in my right ankle (the leg where the presumed foot athrophy and most of the fadsciculations is going on). I also get some bigger "twiches" around my body. This twiching/fasciculations started about a month ago. One week ago I went for a neurography and EMG, which came out normal (I did not have fasciculation at that 30 minutes). The doctor told me that I had strong muscles and that I did not have ALS, which i worry about. I think the doctor who dit the EMG has a long experience and a good reputation. But I still have not seen a neurologist. It was my GP who referred me to the exam after my complaints. I have also done and MRI without contrast, whichs showed no tumor or stroke. The neuro exam by my GP ( a resident) was normal, besides bilateral brisk reflexes. I am somewhat releived by the clean test result, but still have my symtoms. And the thing is that my GP refuse to referr me to a neurologist, since he thinks this is all anxiety related, though I had taken tranquilizers befor the neuro exam, so stress could hardly have been the cause of the brisk reflexes. I live in Sweden whith a health care system that makes second opinion wery hard, I cannot turn to a private neurologist whitouth problems, I have to have an referral from the GP. I feel stuck. Should I put ALS, MS and all to rest or what should I do? I would like to add that I am tapering from benzos at the time and mayby that could explain some of my symtoms but it seems weird that withdrawal would attack assymetrical parts of the body. Some of the symtoms stardes before a began to taper (slowly), ´but of cource I could have developed a low dose addiction at the time, i am just confused and scared.
Thanks!

[Eva_C]

Oh, and I am not sure what inability to perform fine movement means either, where to draw the line. I have mor troubble performing fine movements with my left hand than with my right, but I am right handed. It feels like the different between left and right has gotten bigger when I for exampel right on the computer, but I am not sure. I have no difficulties turning keas with either hand or opening/closing bottles.
It is wery hard to figure out what of this symtoms may come from my benzo tapering, anxiety or a real neurological problem.

[Eva_C]

Hi and thanks for reply!!
I have brisk relfexes, bilateral, but normal strenght, according to GP exam. Could this be normal? the brisk reflexes i mean. They occur in both sides equally. I do not have Babinsky, nor Hoffman sign nor L'Hermitte's
sign.
I do´nt know what decreased motor control is.
MRI brain is performed, but not with contrast, and it was clean as the EMG. I am not sure I can persuade my GP to reffer me to another with contrast or to a neurologist. Also, I am not sure if I have athorphy or not, I think I have a slightly lesser muscle bulc in the right foot where the fasciculations are most persistent and in my left thender muscle.
but if I have athrophy, my strenght is not affected.
I don´t know if asymmetri of the muscles between each hand or foot is normal. I have not given it any notice until now.

[Dr. Kokil Mathur]

Hi!
Liver diseases, hyperthyroidism and weight loss, diabetes, ALS (this has upper motor neuron signs), Charcot Marie Tooth syndrome, multiple sclerosis, Guillain-Barre syndrome, myotonia congenita, muscular dystrophy, and myotonic dystrophy could be the cause of muscle atrophy.
If you have muscle strength and the doctor is unable to find both upper (muscle weakness, decreased motor control, inability to perform fine movements, increased spinal reflexes, and positive Babinski sign—great toe going up) and lower motor (muscle weakness, abnormal EMG etc) neuron signs in your limbs and your EMG is clear then ALS is more or less ruled out. It could be MS and this needs to be confirmed by MRI of brain and a spinal tap (you could ask for this). Other conditions too need to be looked into apart from vit B12 and vitamin D deficiency. Take care!

The medical advice given should not be considered a substitute for medical care provided by a doctor who can examine you. The advice may not be completely correct for you as the doctor cannot examine you and does not know your complete medical history. Hence this reply to your post should only be considered as a guiding line and you must consult your doctor at the earliest for your medical problem.